Review and Recommendations for Drug Testing in Substance Use Treatment Contexts

Drug use implications and the role of testing Drug and alcohol use have been associated with substantial impairments in functioning in a number of settings including driving [1], the work place [2], family functioning [3] and military service [4, 5]. In the United States alone it is estimated that 24.6 million Americans over the age of 12 are current illicit drug users while approximately 137 million Americans are current alcohol consumers [6]. Given the association of drug use with negative outcomes and behaviors including depression [7, 8], criminal offending [9-11], sexual risk [8, 12], poor parenting [13] and cardiovascular disease and death [14, 15], it is important for health practitioners to be able to appropriately identify and, when appropriate, treat problematic substance use. It is within this framework that drug testing methods (DTM) have been used as a detection tool in settings such as the workplace, military, athletics, criminal justice system, health care settings, and drug treatment facilities [16-18]. Drug testing is a complex process that requires a thorough understanding of the substance use process as well as the metabolic processes involved in the absorption, distribution, metabolism and elimination of the used substances. For example, drug testing approaches can vary in terms of the specimen (e.g., urine, blood, hair, sweat, and saliva), substances tested for, the identification time-frame and specificity, the cost of the analysis, frequency of required testing, invasiveness of the drug test, sampling strategy (ex. Random sampling or all subjects are tested), the extent of testing feedback offered to patients, and consequences of positive findings [19]. Additionally, self-report methods as well as physiological testing may be used to screen for drugs. Since drug use may be underreported on a self-report basis, biological testing may be necessary for confirmation purposes [18, 20]. Additionally, drug testing is often used to assess medication compliance within clinical settings that take advantage of medication assisted treatment (MAT). Research has shown that evaluating patient compliance using testing methods can be an important tool with potential for improving outcomes in treatment [21].